- Pediatric palliative care
- Symptom management
- Terminal care
- Nausea and vomiting
- Death rattle
- Seizure control
- Muscle spasm
The majority of children dying from a life-limiting condition suffer from distressing symptoms during their last weeks of life. The provision of current state-of-the-art symptom control is paramount for any health care professional working with dying children, but treatment guidelines are sparse. This article reviews the management of integrative and pharmacological therapies for acute seizure control, anorexia, death rattle, dyspnea, nausea and vomiting, and muscle spasm during the end-of-life period of children and teens. Several myths and misconceptions have led to inadequate symptom control in children with a terminal disease. A dying child is often highly symptomatic, and providing professional integrative and pharmacological symptom relief is one of the many precincts of pediatric palliative care.
Copyright © 2007 S. Karger AG, Basel
- Worden JW, Monahan JR: Caring for bereaved parents; in Armstrong-Daily A, Zarbock S (eds): Hospice Care for Children, ed 2. Oxford, Oxford University Press, 2001, pp 137–156.
- Goldmann A, Hain RDW, Liben S (eds): Oxford Textbook of Palliative Care for Children. Oxford, Oxford University Press, 2006.
- Tyler LS: Dyspnea in palliative care patients; in Lipman AG, Jackson KC 2nd, Tyler LS (eds): Evidence-Based Symptom Control in Palliative Care. New York, Haworth Press, 1999, pp 109–128.
- Westphal CG, Campbell ML: Nebulized morphine for terminal dyspnea: a treatment option in chronic obstructive pulmonary disease or end-stage congestive heart failure. Am J Nurs 2002;102:11–15.
- Cohen SP, Dawson TC: Nebulized morphine as a treatment for dyspnea in a child with cystic fibrosis. Pediatrics 2002;110:e38.
- Chan KS, Sham MMK, Tse DMW, Thorsen AB: Palliative medicine in malignant respiratory diseases; in Doyle D, Hanks G, Cherny N, Calman K (eds): Oxford Textbook of Palliative Medicine, ed 3. Oxford, Oxford University Press, 2004, pp 587–618.
- Scott RC, Besag FM, Neville BG: Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Lancet 2002;353:623–626.
- Jassal SS: Basic Symptom Control in Paediatric Palliative Care: The Rainbows Children’s Hospice Guidelines, ed 4. Loughborough, Leicestershire, Rainbows Children’s Hospice, 2002.
- Cotanch P, Hockenberry M, Herman S: Self-hypnosis as antiemetic therapy in children receiving chemotherapy. Oncol Nurs Forum 1985;12:41–46.
- Jacknow DS, Tschann JM, Link MP, Boyce WT: Hypnosis in the prevention of chemotherapy-related nausea and vomiting in children: a prospective study. J Dev Behav Pediatr 1994;15:258–264.
- Zeltzer L, LeBaron S, Zeltzer PM: The effectiveness of behavioral intervention for reducing nausea and vomiting in children and adolescents receiving chemotherapy. J Clin Oncol 1984;2:683–690.
- Vickers AJ: Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med 1996;6:303–311.
- Twycross R, Back I: Nausea and vomiting in advanced cancer. Eur J Palliat Care 1998;5:39–44.
- Stiakaki E, Savvas S, Lydaki E, Bolonaki I, Kouvidi E, Dimitriou H, Kambourakis A, Kalmanti M: Ondansetron and tropisetron in the control of nausea and vomiting in children receiving combined cancer chemotherapy. Pediatr Hematol Oncol 1999;16:101–108.
- Brock P, Brichard B, Rechnitzer C, Langeveld NE, Lanning M, Soderhall S, Laurent C: An increased loading dose of ondansetron: a north European, double-blind randomised study in children, comparing 5 mg/m2 with 10 mg/m2. Eur J Cancer 1996;32A:1744–1748.
- Ozkan A, Yildiz I, Yuksel L, Apak H, Celkan T: Tropisetron (Navoban) in the control of nausea and vomiting induced by combined cancer chemotherapy in children. Jpn J Clin Oncol 1999;29:92–95.
- Uysal KM, Olgun N, Sarialioglu F: Tropisetron in the prevention of chemotherapy-induced acute emesis in pediatric patients. Turk J Pediatr 1999;41:207–218.
- Aksoylar S, Akman SA, Ozgenc F, Kansoy S: Comparison of tropisetron and granisetron in the control of nausea and vomiting in children receiving combined cancer chemotherapy. Pediatr Hematol Oncol 2001;18:397–406.
- Smith AR, Repka TL, Weigel BJ: Aprepitant for the control of chemotherapy induced nausea and vomiting in adolescents. Pediatr Blood Cancer 2005;45:857–860.
- Hall W, Degenhardt L: Medical marijuana initiatives: are they justified? How successful are they likely to be? CNS Drugs 2003;17:689–697.
- Grotenhermen F, Bialas B: Cannabinoide in der Medizin. Rheinisches Arztebl 2003;12:21–22.
- Mercandante S, Spoldi E, Caraceni A: Octreotide in relieving gastrointestinal symptoms. Palliat Med 1993;7:295–299.
- Khoo D, Hall E, Motson R, Riley J, Denman K, Waxman J: Palliation of malignant intestinal obstruction using octreotide. Eur J Cancer 1994;30A:28–30.
- Eubanks V, Koppersmith N, Wooldridge N, Clancy JP, Lyrene R, Arani RB, Lee J, Moldawer L, Atchison J, Sorscher EJ, Makris CM: Effects of megestrol acetate on weight gain, body composition, and pulmonary function in patients with cystic fibrosis. J Pediatr 2002;140:439–444.
- Clarick RH, Hanekom WA, Yogev R, Chadwick EG: Megestrol acetate treatment of growth failure in children infected with human immunodeficiency virus. Pediatrics 1997;99:354–357.
- Marchand V, Baker SS, Stark TJ, Baker RD: Randomized, double-blind, placebo-controlled pilot trial of megestrol acetate in malnourished children with cystic fibrosis. J Pediatr Gastroenterol Nutr 2000;31:264–269.
- Dangel T: Domowa opieka paliatywna nad dziecmi w Polsce. Warsaw, Department of Palliative Care, Institute for Mother and Child, 2001.
- Drake R, Frost J, Collins JJ: The symptoms of dying children. J Pain Symptom Manage 2003;26:594–603.
- Goldman A: Symptoms and suffering at the end of life in children with cancer – correspondence. N Engl J Med 2000;342:1997–1999.
- Hongo T, Watanabe C, Okada S, Inoue N, Yajima S, Fujii Y, Ohzeki T: Analysis of the circumstances at the end of life in children with cancer: symptoms, suffering and acceptance. Pediatr Int 2003;45:60–64.
- Wolfe J, Grier HE, Klar N: Symptoms and suffering at the end of life in children with cancer. N Engl J Med 2000;342:326–333.
Stefan J. Friedrichsdorf, MD
Pain and Palliative Care Department, Children’s Hospitals and Clinics of Minnesota
2525 Chicago Avenue South, Minneapolis, MN 55404 (USA)
Tel. +1 612 813 6100, Fax +1 612 813 6358
The authors have made extensive efforts to ensure that treatments, drugs and dosage regimens in this article are accurate and conform to the standards accepted at the time of the publication. However, changes in information through continuing research and clinical experience and the possibility of human error warrant that the authors do not accept any responsibility for any loss or damage arising from actions or decisions based on information in this article: the ultimate responsibility for the treatment of patients and interpretation of published material lies with the medical practitioner. There are standard on-line references for current dosing information and one of these should be consulted.
Received: June 29, 2005
Revised: February 6, 2006
Number of Print Pages : 7
Number of Figures : 0, Number of Tables : 3, Number of References : 31
Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)
Vol. 16, No. Suppl. 1, Year 2007 (Cover Date: August 2007)
Journal Editor: Owunwanne, A. (Kuwait)
ISSN: 1011–7571 (print), 1423–0151 (Online)
For additional information: http://www.karger.com/MPP
Open Access License / Drug Dosage / Disclaimer
Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license
), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.